The Pros and Cons of Concierge Care

Is it worth paying extra to become a VIP at your doctor's office?

You just got a letter from your doctor announcing "major news": He or she is converting the office to a “concierge” practice. Rather than caring for a thousand patients or more, the physician is cutting back to a few hundred, who will now get more of his or her time and attention. To become one of these patients, you’ll have to pay an annual retainer, or fee, of about $1,500. If you can’t or won’t pay, you may have to find a new doctor.

If you love your doctor and can afford the fee, you may just shrug and pay up. If you require frequent, in-depth appointments, you might even welcome the switch. With concierge care, doctors can promise greater availability, longer appointments, quicker lab results and personal hospital visits.

Some physicians believe that concierge care takes them back to the way they used to be able to interact with patients, before financial pressures forced them to see ever more patients and give each less time. But even the most dedicated doctors are pursuing their own interests as much as yours when they switch to concierge practice, also known as boutique, VIP, retainer-based or direct-pay medicine.

The number of such practices in the U.S. is still fairly small — an estimated 4,400, according to the American Academy of Private Physicians, a trade group. But that number is growing quickly as more physicians, aggravated by cost squeezes in the system, seek ways to maintain or increase their incomes while streamlining their workloads.

A concierge practice can have benefits, but before signing on with your doctor, you need to understand exactly what you’ll be getting. Management advisers such as MDVIP and Concierge Choice Physicians offer doctors who join their networks a blueprint for their revamping their practice. But there is no standard model. The annual fee that can range from a few hundred dollars to several thousand, and what you receive in exchange for that money may vary widely.

The additional fee might only buy you the right to keep seeing your doctor, with quicker appointments and more time set aside for in-depth consultations. It may cover the cost of some or all standard office visits and tests, as well as house calls in some practices, but that's not always the case. In some practices, concierge patients receive an annual exam at no extra charge, or perks like unlimited email or cell phone contact with the doctor or a thumb drive containing personal medical records.

The concierge model often promotes “patient-centered wellness care," with an emphasis on avoiding health problems or better managing existing ones through medical monitoring and preventive services. MDVIP claims that hospitalization rates among patients in its practices are more than 70 percent lower than in non-concierge offices. The company reports that 180,000 patients, with an average age of 55, see physicians in its network.

Insurance, of course, is a major variable in anyone's decision to join a concierge practice. Some doctors continue to accept insurance after they make the switch, but many do not. Either way, says Susan Pisano, a spokesperson for the industry trade group America’s Health Insurance Plans, “I don’t know of any insurer who reimburses a retainer." If the doctor no longer accepts private insurance, patients are faced with paying out of pocket for services not covered by the retainer and filing claims to seek reimbursement.

Medicare restricts what physicians can charge for covered benefits, like office visits. The federal program will not cover any doctor's concierge fee, but has yet to establish whether charging such a fee for extra time and attention, even when it’s not billed to Medicare, still violates the program's payment limits. To avoid any potential conflict, some concierge physicians drop out of Medicare altogether, in which case their Medicare patients must pay the doctor directly for all services, with no reimbursement from the program.

Even if cost is not a major issue for you, you may be uncomfortable with the idea of your doctor imposing a fee for access. Some concierge physicians continue to serve a small number of patients who can’t afford the fee, and a number of “hybrid” practices have two tiers of patients, with those who decline to pay the fee getting no extra benefits.

Does concierge care make sense for you? Here are some factors to consider:

What's the value? Patients with complex or chronic medical conditions are likely to get the most out of better access and more attention from their doctors. For those with less frequent or serious needs, the promise of seeing the doctor more quickly and having longer appointments may not be worth paying an annual retainer, especially if your doctor also stops taking your insurance.

How different will my care really be? Consider the care you’re already entitled to, with or without concierge service. The federal health reform law, for example, now covers virtually all insured patients for free preventive screenings; Medicare beneficiaries also get a free annual exam.

How much more will it cost? If you stay with a practice that no longer accepts your insurance, you will have to begin filing your own claims or even pay out of pocket.

Can I get a test drive? Some concierge practices charge by the month, and others will prorate a refund based on an annual fee. So you could try a program to see if it seems worthwhile.